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SURGICAL: Cardiac Valve Procedures with CC

M itral stenosis, a pathological narrowing of the orifice of the mitral valve, occurs when the mitral valve is unable to open fully. The opening of the mitral valve, normally 4 to 6 cm2 in area, is decreased to half normal size or even smaller because of a series of changes in valve structure. The mitral valve leaflets fuse together and become stiff and thickened by fibrosis and calcification. The chordae tendineae fuse together and shorten, and the valvular cusps lose their flexibility.

The mitral valve is located between the left atrium and the left ventricle. When mitral stenosis occurs, blood can flow from the left atrium to the left ventricle only if it is moved forward by an abnormally elevated left atrial pressure. The elevated left atrial pressure leads to increased pulmonary venous and capillary pressures, decreased pulmonary compliance, and exertional dyspnea. Left atrial dilatation, an increase in pulmonary artery pressure, and right ventricular hypertrophy follow as the heart compensates for the stenotic valve.

Complications of mitral stenosis can be serious. With no surgical intervention, 20 years after the onset of symptoms the condition can result in an 85% mortality rate. Pulmonary edema develops with sudden changes in flow across the mitral valve, such as the increased flow that occurs in exercise. Atrial dysrhythmias, particularly paroxysmal atrial tachycardia, atrial flutter, and atrial fibrillation, occur with more long-standing disease. Pulmonary hypertension can cause fibrosis of the alveoli and pulmonary capillaries. Recurrent pulmonary emboli, pulmonary infections, infective endocarditis, and systemic embolization are all potential complications.

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